About 15 percent of children in the United States are chronically ill. These children with special health care needs (CSHCN) account for half of all child hospital days nationwide, require many more medical visits than other children, and miss many more days of school. Their parents face special challenges as they struggle to balance work and the needs of their sick children. The federal Family and Medical Leave Act (FMLA) was intended in part to provide help by guaranteeing parents of ill children up to 12 weeks of unpaid leave, with protection against being fired. The effect of FMLA, however, has been limited. Fewer than half of U.S. employees are eligible for the program; in a national survey, nearly 80 percent of eligible parents who didn't take advantage of FMLA said they couldn't afford to take the unpaid leave. In response to this need for greater access to both leave and pay during leave, the federal government and several states have considered enacting paid family leave programs. California was the first state to implement one, beginning the Paid Family Leave Insurance (PFLI) program in 2004. The adoption of PFLI provided a natural experiment, allowing a team of RAND analysts to assess use and health effects of paid and unpaid leave among parents of CSHCN in California before and after PFLI and to compare those effects with leave-taking among similar parents in another state over the same time frames. (Contains 5 figures.) [This highlight summarizes RAND health research reported in the following publications: (1) Chung PJ, Garfield CF, Elliott MN, Carey C, Eriksson C, and Schuster MA, "Need for and Use of Family Leave Among Parents of Children with Special Health Care Needs," "Pediatrics", Vol. 119, No. 5, May 2007, pp. e1047-e1055; (2) Schuster MA, Chung PJ, Elliott MN, Garfield CF, Vestal KD, and Klein DJ, "Perceived Effects of Leave from Work and the Role of Paid Leave Among Parents of Children with Special Health Care Needs," "American Journal of Public Health", Vol. 99, No. 4, April 2009, pp. 698-705; and (3) Schuster MA, Chung PJ, Elliott MN, Garfield CF, Vestal KD, and Klein DJ, "Awareness and Use of California's Paid Family Leave Insurance Among Parents of Chronically Ill Children," "Journal of the American Medical Association", Vol. 300, No. 9, Sept. 2008, pp. 1047-1055.]